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Original Research |

Pulmonary rehabilitation as a mechanism to reduce hospitalizations for acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis

Elizabeth Moore, MSc; Thomas Palmer, MSc; Dr Roger Newson, PhD; Prof Azeem Majeed; Dr Jennifer K Quint, MRCP, PhD; Dr Michael A Soljak, PhD
Author and Funding Information

Conflicts of Interest Statement: JKQ reports grants from the Medical Research Council (MRC), GlaxoSmithKline (GSK), British Lung Foundation (BLF), Wellcome Trust, during the conduct of the study, and personal fees from AstraZeneca and GSK outside of the submitted work. MS reports other current research grants from Arthritis Research UK, Public Health England and the EU EITHealth Programme, with no conflicts of interest. No other conflicts of interest are reported.

Department of Respiratory Epidemiology Occupational Medicine and Public Health, Imperial College London, London, UK

Department of Primary Care and Pubic Health, Imperial College London, London, UK

Department of Primary Care and Pubic Health, Imperial College London, London, UK

Department of Primary Care and Pubic Health, Imperial College London, London, UK

Department of Respiratory Epidemiology Occupational Medicine and Public Health, Imperial College London, London, UK

Department of Primary Care and Pubic Health, Imperial College London, London, UK

Correspondence to: Elizabeth Moore, Imperial College London. National Heart and Lung Institute, Emmanuel Kaye Building, 1B Manresa Road, London, SW3 6LR.


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.05.038
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Abstract

Background  Acute exacerbations of COPD (AECOPD) have a significant impact on healthcare utilization, including physician visits and hospitalizations. Previous studies and reviews have shown that pulmonary rehabilitation has many benefits but the effect on hospitalizations for AECOPD is inconclusive.

Methods  A literature search was carried out to find studies that might help determine, using a meta-analysis, the impact of pulmonary rehabilitation on AECOPD, defined as unscheduled or emergency hospitalizations and emergency room (ER) visits. Cohort studies and randomised controlled trials (RCTs) reporting hospitalizations for AECOPD as an outcome were included. Meta-analyses compared hospitalization rates between eligible pulmonary rehabilitation recipients and non-recipients, before and after rehabilitation.

Results  18 studies were included in the meta-analysis. Results from ten RCTs showed that the control groups had a higher overall rate of hospitalizations than the pulmonary rehabilitation groups (0.97 hospitalizations/patient-year, 95% Confidence Intervals (CIs) 0.67, 1.40; 0.62 hospitalizations/patient-year, 95% CI 0.33, 1.16 respectively). Five studies compared admission numbers in the 12 months before and after rehabilitation, finding a significantly higher admission rate before compared to after (1.24 hospitalizations/patient-year, 95% CIs 0.66, 2.34; 0.47 hospitalizations/patient-year, 95% CIs 0.28, 0.79 respectively). The pooled result of three cohort studies found the reference group had a lower admission rate compared to the pulmonary rehabilitation group (0.18 hospitalizations/patient-year, 95% CI 0.11, 0.32 for reference group versus 0.28 hospitalizations/patient-year, 95% CI 0.25, 0.32 for pulmonary rehabilitation).

Conclusions  Although results from RCTs suggested that pulmonary rehabilitation reduces subsequent admissions, pooled results from the cohort studies did not, likely reflecting the heterogeneous nature of individuals included in observational research and the varying standard of pulmonary rehabilitation programmes.


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